1649397936 NPI number — MRS. JUNE MURIEL THURSTON LSWC

Table of content: MRS. JUNE MURIEL THURSTON LSWC (NPI 1649397936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649397936 NPI number — MRS. JUNE MURIEL THURSTON LSWC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THURSTON
Provider First Name:
JUNE
Provider Middle Name:
MURIEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LSWC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADDINGTON
Provider Other First Name:
JUNE
Provider Other Middle Name:
MURIEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649397936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 378
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04937-0378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-453-4365
Provider Business Mailing Address Fax Number:
207-453-4371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04937-1337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-453-4365
Provider Business Practice Location Address Fax Number:
207-453-4371
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  LSX9164 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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